Healthcare Provider Details

I. General information

NPI: 1548297617
Provider Name (Legal Business Name): JEFFREY DEAN HODGDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N. SANTA FE SUITE 2010
OKLAHOMA CITY OK
73118-7532
US

IV. Provider business mailing address

PO BOX 269064
OKLAHOMA CITY OK
73126-9064
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-5555
  • Fax: 405-272-5517
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19214
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: